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Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: Medical
Satisfied Customers: 59190
Experience:  MBBS MS. Post doctoral fellowship in Sports Medicine. General surgeon and sports medicine specialist
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I’m on holiday in Siloth, I’ve had a cough for over 5 weeks

Customer Question

Hello, I’m on holiday in Siloth, I’ve had a cough for over 5 weeks and have not been able to get appointment with my gp. Since Sunday I have felt unwell coughing constantly coughing up green phlegm, headache. Today I feel really ill and quite breathless. I’ve contacted my own gp at home, they have no appointments to speak with a doctor until Saturday, I’m desperate to see if someone can help me as I feel really unwell. The receptionist at my gp told me to contact 111. I had a covid test on the 4 th of September which came back negative. Please can you help. Thank you.
JA: How long have you been dealing with the cough? Are you having any other symptoms?
Customer: 5-6 weeks, I’ve tried to do everything to help myself. Felling breathless at times, headache and very sore ribs with coughing.
JA: Is there anything else the Doctor should know before I connect you? Rest assured that they'll be able to help you.
Customer: nothing else, and thank you.
Submitted: 18 days ago.
Category: Medical
Expert:  Dr. Arun Phophalia replied 18 days ago.

What are your age and gender?

Do you have a fever, acid reflux/heartburn, known allergies, sinusitis, history of asthma?

Customer: replied 18 days ago.
60 years old female, allergic to penicillin.
Expert:  Dr. Arun Phophalia replied 18 days ago.

Thanks for the further information.

I am writing the answer for you and will get back to you in 5 minutes.

Unless you wish to speak in person, you can ignore the request for a phone call automatically generated by the website, not by me.

Thank you.

Expert:  Dr. Arun Phophalia replied 18 days ago.

Apologies for any intrusion of those automatic offers for phone calls. These are produced by the website automatically and outside of my control.

Expert:  Dr. Arun Phophalia replied 18 days ago.

The common causes of chronic cough are postnasal drip (also called upper airway cough syndrome), asthma, and reflux laryngitis / gastroesophageal reflux disease (GERD). These causes are responsible for up to 90 percent of all cases of chronic cough. Less common causes include infections, medications, and chronic lung diseases. Another common cause of chronic cough is nonasthmatic eosinophilic bronchitis. Following causes are usually considered for the chronic cough;

1) Upper airway cough syndrome; comprise of vasomotor rhinitis; acute nasopharyngitis; and sinusitis. The treatment is by steroid nasal spray or nasal antihistamine. Sinusitis may need antibiotics like trimethoprim-sulfamethoxazole or cefuroxime.

2) Cough variant asthma; will require bronchodilator medications used in asthma or steroid inhalers.

3) Reflux laryngitis and Gastroesophageal reflux disease (GERD); treatment is by avoidance of reflux-inducing foods (fatty foods, chocolate), eating five small meals a day without snacking, avoidance of meals for two to three hours before lying down (except for medications), the elevation of the head of the bed and an H2 antagonist or a proton pump inhibitor.

4) Postnasal drip; would need antihistamines and inhaled ipratropium bromide.

5) Non-specific cough; Dextromethorphan and/or codeine can be used.

The diagnostic and management protocol for chronic cough is as following;

1) we will do a chest x-ray first;

2) pulmonary function tests or spirometry is the second step

3) starting empiric therapy for postnasal drip, asthma, or gastroesophageal reflux. The GERD can be sometimes uncontrolled despite the medications and this will need further evaluation in the form of esophageal manometry (food pipe pressure study) and pH study of the food pipe (esophagus).

4) methacholine challenge testing to evaluate for airway hyperreactivity; done for the bronchospasm / bronchial asthma.

5) sputum or phlegm examination for eosinophils or empiric trial of corticosteroids for eosinophilic bronchitis.

If despite these measures, cough persists we would consider further investigations like esophagoscopy, 24-hour pH probe monitoring, high-resolution chest CT, or bronchoscopy.

I hope your symptoms resolve soon.

I would be happy to assist you further if you need any more information.
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